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針對目前有的糖尿病老祖宗大類作比較~
藥物 | Glimepirid (Amaryl) | Glyburide (Euglucon) | Glipizide (Minidiab) | Gliclazide (Diamicron MR) |
劑型劑量 | 2mg/tab | 5mg/tab | 5mg/tab | 80mg/tab |
使用劑量 | 1. Initial: 1 ~ 2 mg QD 2. Maintenance:1~ 4 mg QD 3. MAX 8 mg daily | 1. Initial: 2.5-5 mg QD 2. Maintenance: 1.25-20 mg QD or in 2 divided doses 3. MAX 20 mg/day | 1. Initial: 5 mg QD 2. Maintenance: MAX 40 mg daily (if dose exceeds 15 mg, divide into at least 2 doses | 1. initial : 40~ 80 mg QD 2. Maximum : 320 mg daily |
分類 | Sulfonylureas | |||
機轉 | 1. 阻斷β-cell的ATP依賴性K+ 通道，使β-cell去極化，產生脫顆粒作用，釋放胰島素 (major) 2. 降低肝臟製造葡萄糖的能力 3. 加強周邊對胰島素的敏感性 4. 必須在胰臟仍有分泌胰島素功能時才有作用 5. 使用時需監測血糖值及HbA1c | |||
Onset | 2~4 hr | 30 min | 30 min | 4 ~ 5 hr |
Duration | 24 hr | 16~24 hr | 10~24 hr | 24 hr |
T1/2 | 9 hr | 5~10 hr | 2~5 hr | 8 ~12 hr |
Excretion | Fecal: 40% Renal: 60% | Renal and biliary= 50%:50% | Renal: 63~89% feces: 20% | Renal: 60% to 80% Feces, 20% |
Contraindications | 1. diabetic ketoacidosis 2. pregnancy complicated by diabetes mellitus | diabetic ketoacidosis | ||
Precautions | 1. susceptible to hypoglycemia: ü elderly, debilitated, or malnourished patients ü hepatic insufficiency ü stress caused by infection, fever, trauma, or surgery 2. lactation | 1. susceptible to hypoglycemia : ü elderly, debilitated, or malnourished patients ü adrenal or pituitary insufficiency ü hepatic or renal insufficiency ü stress caused by infection, fever, trauma, or surgery 2. pregnancy or lactation | 1. Hypoglycemia 2. Liver disease 3. Periods of stress (eg, infection, fever, trauma, surgery) (insulin may be needed) 4. Renal insufficiency, moderate-to-severe | |
Note | AC | 1. titrate dose slowly if used concurrently with metformin 2. AC or PC | give 30 min before a meal | AC or PC |
測血糖時間 | 監測血糖時間點：一天二次，空腹時monitor | |||
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